Provider Demographics
NPI:1043048523
Name:MOBILE PHLEBOTOMIST SERVICES
Entity type:Organization
Organization Name:MOBILE PHLEBOTOMIST SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:951-973-6030
Mailing Address - Street 1:962 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-4250
Mailing Address - Country:US
Mailing Address - Phone:951-973-6030
Mailing Address - Fax:951-654-8600
Practice Address - Street 1:962 OVERTON DR
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-4250
Practice Address - Country:US
Practice Address - Phone:951-973-6030
Practice Address - Fax:951-654-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No251E00000XAgenciesHome Health